Individual
MS. HOLLY RAE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LADAC
Contact information
Practice address
413 SIPAPU ROAD, TAOS, NM 87571
(575) 758-5857
(575) 758-2832
Mailing address
750 GUSDORF # 308, TAOS, NM 87571
(575) 758-9666
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0065382
NM
Other
Enumeration date
01/23/2009
Last updated
01/23/2009
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